Medical device programmer with selective disablement of display during telemetry

ABSTRACT

In general, the invention is directed to a patient programmer for an implantable medical device. The patient programmer may include one or more of a variety of features that may enhance performance, support mobility and compactness, or promote patient convenience. For example, a patient programmer may include both an internal antenna for RF telemetry with an implantable medical device and a display. The patient programmer may include a processor or other control circuitry that selectively disables. i.e., turns off, the display during RF telemetry with the internal antenna to promote more reliable communication. The processor or control circuitry also may disable electronics associated with the display during a telemetry session. In this manner, the programmer can be configured to reduce the impact of electrical and electromagnetic noise on telemetry performance.

This application claims priority from U.S. provisional application Ser.No. 60/508,511, filed Oct. 2, 2003, the entire content of which isincorporated herein by reference.

TECHNICAL FIELD

The invention relates to medical devices and, more particularly, tohandheld programmers for medical devices.

BACKGROUND

Medical devices are used to deliver therapy to patients to treat avariety of symptoms or conditions, and may be implantable or external.An implantable neurostimulator, for example, may treat symptoms orconditions such as chronic pain, tremor, Parkinson's disease, epilepsy,incontinence, or gastroparesis. The implantable medical device deliversneurostimulation therapy via one or more leads that include electrodeslocated proximate to the spinal cord, pelvic nerves, or stomach, orwithin the brain of a patient. In general, the implantable medicaldevice delivers neurostimulation therapy in the form of electricalpulses.

A clinician selects values for a number of programmable parameters inorder to define the neurostimulation therapy to be delivered to apatient. For example, the clinician may select an amplitude, which maybe a current or voltage amplitude, and pulse width for a stimulationwaveform to be delivered to the patient, as well as a rate at which thepulses are to be delivered to the patient. In addition, the clinicianalso selects particular electrodes within an electrode set to be used todeliver the pulses, and the polarities of the selected electrodes.

The clinician uses a clinician programmer to program the parameters intothe implantable medical device. The implantable medical device may storemultiple programs, however, which may be selected by the patient using apatient programmer. The patient may select different programs to modifytherapy delivered by the implantable medical devices, e.g., to achievegreater pain relief. Different programs may be appropriate for differenttimes of day or different physical activities or postures.

The patient programmer communicates with the implantable medical deviceto modify programs using radio frequency (RF) telemetry. For thisreason, the patient programmer includes an external antenna with an RFtelemetry head for placement on the patient's body at a position nearthe implantable medical device. The patient programmer is typicallydesigned as a mobile device that may be carried by the patientthroughout the course of the day. For example, the patient programmermay be a handheld device, and typically is powered by batteries withinthe device.

SUMMARY

In general, the invention is directed to a handheld programmer, such asa patient programmer, for a medical device. The medical device may be animplantable medical device, an external medical device, or a medicaldevice with external and implanted components. The handheld programmerwill be described in conjunction with an implantable neurostimulator forpurposes of illustration. The patient programmer may include one or moreof a variety of features that may enhance performance, support mobilityand compactness, or promote patient convenience.

For example, a patient programmer in accordance with an embodiment ofthe invention may include both an internal antenna for RF telemetry withan implantable medical device and a display device. An external antennaalso may be attached to the patient programmer via a cable, and mayinclude an RF telemetry head for placement on the patient's body at aposition near an implanted medical device.

The small nature of the handheld patient programmer makes it desirableto locate the display, internal antenna, batteries and printed circuitsboard in very close proximity to each other. However, when any of thesecomponents are located near each other, poor RF communication can resultfrom a number of electronic issues such as: noise injection, noisecoupling, and unwanted antenna loading. The invention described herein,in some embodiments, addresses these issues and results in a smallhandheld device with superior and reliable RF communication.

The internal antenna is mounted within the patient programmer housing,and may have a structure designed for performance and compactness. Inaddition, the internal antenna may facilitate programming of theimplanted medical device by simply placing the patient programmer on thepatient's body at a position near the implanted medical device, therebypromoting patient convenience.

In addition, the internal antenna may have a loop-like structure thatdefines a central aperture. The central aperture may be shaped and sizedto accommodate insertion of one or more batteries into the programmer.In some embodiments, the loop-like structure may be substantiallyrectangular. The batteries may be mounted in a battery bay within theantenna aperture. In some embodiments, the battery bay protrudes intothe antenna aperture from the patient programmer housing.

The batteries may be placed in the battery bay via an access door on theoutside of the patient programmer housing. In some cases, the batteriesmay contribute favorably to the RF load presented to the internalantenna. In particular, the batteries may present an additional load tothe internal antenna, enhancing immunity to electrical andelectromagnetic interference during telemetry sessions with theimplantable medical device. To further reduce electrical andelectromagnetic interference, the internal antenna may be constructedwith a woven copper braid that enhances shielding and reduces antennaloading during transmission and reception.

The display in the patient programmer may include a display screen, suchas a liquid crystal display (LCD), to present status information andother messages to the patient. To reduce the effects of electrical andelectromagnetic interference produced by the display screen, andassociated display electronics, on telemetry performance, the displayscreen and internal antenna may be displaced from one another within thepatient programmer housing.

For example, the antenna and associated transmit and receive electronicsmay be mounted on a first circuit board, and the display and associateddisplay electronics may be mounted on a second circuit board. The firstand second circuit board may occupy different planes, displaced from oneanother, within the patient programmer housing. However, the display andantenna may overlap one another, providing a compact, stack-likeconfiguration.

The internal antenna may be mounted on an outward-facing side of thefirst circuit board, and the display may be mounted on an outward-facingside of the second circuit board. In some embodiments, the internalantenna may be mounted to a bottom housing cover above the surface ofthe first circuit board, and electrically connected to the circuit boardvia a connector. In this manner, the internal antenna also may bedisplaced from the first circuit board.

The separation distance between the circuit boards may serve to reducethe effects of electrical and electromagnetic interference caused by thedisplay on signals transmitted and received by the internal antenna. Inaddition, the placement of the antenna and display electronics ondifferent circuit boards may reduce electrical and electromagneticinterference. In summary, the internal antenna arrangement provides acompact design, but reduces the effects of circuit board noise ontelemetry performance.

In some embodiments, a majority of digital electronics may be placed onthe first circuit board with the display, and a majority of analog andRF electronics may be placed on the second circuit board. Consequently,much of the digital electronics on one circuit board may be selectivelyturned off during telemetry sessions administered by analog componentson the other circuit board. In this manner, the programmer can beconfigured to reduce the impact of significant electrical andelectromagnetic noise on telemetry performance.

For example, the patient programmer may include a processor or othercontrol circuitry that selectively disables, i.e., turns off, thedisplay during RF telemetry with the internal antenna to promote morereliable communication. The processor or control circuitry also maydisable electronics associated with the display during a telemetrysession. For example, the display and display electronics may betemporarily disabled during reception of RF signals from the IMD,transmission of RF signals to the IMD, or both.

In this manner, the patient programmer selectively controls the displayand display electronics to reduce electrical and electromagneticinterference. The processor enables the display and display electronicsupon completion of telemetry. When use of an external antenna isdetected, the processor may enable the display, as electrical andelectromagnetic interference may be less of a concern for the externalantenna, which extends away from the patient programmer via a cable,e.g., by several inches or feet.

The patient programmer also may feature a stacked configuration thatpermits Z-axis assembly of the components of the programmer, including abottom housing cover, the antenna, the antenna circuit board, thedisplay circuit board, a display lens cover faceplate that protects thedisplay, input buttons, and the top housing cover. In this manner, thevarious components may be stacked on top of one another to build thepatient programmer from back to front.

The display lens cover faceplate may be an in-mold decorated lensfaceplate that can be printed with distinctive indicia just prior toassembly to customize the appearance of the programmer, and theninserted into the front housing cover, e.g., within a recessed area oropening in the front housing cover. In some cases, the display lenscover faceplate may be printed with personalization information, such aspatient name, address and phone number.

Also, the display lens cover faceplate may carry different graphics todistinguish different types of therapy delivered by the medical device,or distinguish different model types. The faceplate also may be madewith different configurations that expose different sets of buttons, andmay have different appearances, including different colors,illustrations, and designs, while fitting in a common mounting area.Such features, including particularly different sets of buttons, may beappropriate to particular types or models of medical devices.

An external antenna used with the patient programmer may include a cableand a loop-like telemetry head at one end of the cable. The loop-liketelemetry head is placed on the patient's body at a position near theimplanted medical device. The loop-like telemetry-head may define aunique aperture with a wide end and a narrow, tapered end, e.g.,somewhat similar to the shape of a tear drop. The narrow, tapered end ofthe aperture defines a channel or “notch” designed to capture clothingworn by the patient to thereby hold the telemetry head in place near theimplanted medical device during programming. When the clothing, such asa shirt, is forced into the channel, an interference fit or frictiontends to hold the clothing and the telemetry head in place relative toone another.

In some embodiments, the patient programmer may be programmed via asoftware loading port, such as a JTAG interface. In particular, theprogrammer may include nonvolatile memory, such as flash memory or CPLDsthat may be programmed with basic operating system functionality andprograms via a software loading port during initial assembly. Thesoftware loading port may be exposed via the front housing cover, e.g.,prior to place of the lens cover faceplate. For example, the fronthousing cover may present an aperture that permits access to thesoftware loading port, but is covered by the lens cover faceplate whenit is placed in the front cover housing. In this manner, the programmermay be programmed as one of the final steps in the manufacturingprocess.

This feature enables a large number of programmers to be preassembled,placed in storage if desired, and then programmed for operation with anappropriate type of medical device, e.g., just before the lens coverfaceplate is placed in the front housing cover. A programming head maybe sized and shaped to engage the software loading interface anddownload software from a host computer such as a handheld computingdevice. Hence, large numbers of programmers can be stockpiled, and thenloaded with appropriate operating system and application software tospecially configure the programmer with one of a plurality of functionalsets for use with a specific type of programmer and IMD.

Following assembly, the patient programmer may be reprogrammed, updatedor upgraded via an infrared interface provided in the patientprogrammer. Unlike the software loading port, which may be covered bythe lens cover faceplate upon assembly, the infrared interface isexposed for interaction with an infrared communication device. Forexample, the infrared interface may be activated when the device ispowered up, e.g., by activating an “on” button on the patient programmeror replacing batteries in the programmer. Upon power-up, the infraredinterface enters a programming state, i.e., a listening period, in whichit is capable of establishing an infrared communication session forfield updates and upgrades to the embedded operating system.

For example, the infrared interface may remain active for initiation ofa communication session for a period of time following power-up, i.e., afinite listening period. A dedicated programming device or a clinicianprogrammer may include an infrared interface to communicate with theinfrared interface of the patient programmer, and provide updates tosoftware or firmware. In this manner, the embedded operating system and,in some cases, medical device programs in the patient programmer may beupdated in the field. If no external infrared communication device isdetected within a period of time, e.g., seconds, following power-up, theinfrared interface may go inactive. The infrared interface for updatesand upgrades in the field may be provided in addition to a softwareloading interface that is used to initially load the operating systemsoftware and application software upon manufacture and assembly of theprogrammer.

In accordance with another embodiment, a circuit board within theprogrammer, e.g., a circuit board on which an internal antenna ismounted or placed nearby, may be configured to further promote telemetryperformance. For example, a ground plane may be provided with asubstantially continuous ground plane area interrupted by a plurality ofgaps that extend generally outward from a center of the circuit board. Asingle, contiguous ground plane area is desirable to provide a lowimpedance return path for electrical signals transmitted via traces onsignal planes. The gaps define sub-areas, which may be dedicated toproviding low impedance return paths to maintain signal integrity forrespective signal groups on the signal planes.

In addition, the signal planes in the antenna circuit board may beconfigured to present a reduced magnetic load to the magnetic circuitoperating on the antenna. Reduction or elimination of surface area ofthe conductive signal planes within the antenna aperture serves toreduce the magnetic load to the magnetic circuit of antenna. Inparticular, the signal planes may include electrostatic discharge layersthat define apertures in alignment with, and sized and shaped similarlyto, the aperture of antenna to substantially reduce the magnetic load.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a conceptual diagram illustrating a system for programming anddelivering medical therapy.

FIG. 2 is a block diagram illustrating a patient programmer forprogramming an implantable medical device.

FIG. 3 is a flow diagram illustrating a technique for selectivelyenabling and disabling a display to reduce electrical andelectromagnetic interference during telemetry.

FIG. 4 is a perspective view of a patient programmer.

FIG. 5 is a partially exploded view of a patient programmer.

FIG. 6A is a perspective view of an external antenna for use with apatient programmer.

FIG. 6B is a perspective view of an external antenna attached to apatient's shirt.

FIG. 7 is a perspective view of a patient programmer.

FIG. 8 is a perspective view illustrating the patient programmer of FIG.7 with the top housing cover removed and an interior view of the tophousing cover.

FIG. 9 is a perspective view illustrating the patient programmer of FIG.7 with the top housing cover and display circuit board removed.

FIG. 10 is a perspective view illustrating the patient programmer ofFIG. 7 with the top housing cover, display circuit board and antennacircuit board removed.

FIG. 11 is a perspective view illustrating the patient programmer ofFIG. 7 with the top housing cover, display circuit board and antennacircuit board removed, and an antenna-side view of the antenna circuitboard.

FIG. 12 is a perspective view illustrating the antenna circuit board andbottom housing cover of the patient programmer of FIG. 7.

FIG. 13 is a perspective view illustrating a side view of the displaycircuit board and the antenna circuit board.

FIG. 14 is a perspective view illustrating a second side view of thedisplay circuit board and the antenna circuit board.

FIG. 15 is a perspective view illustrating the bottom housing cover witha battery bay and an internal antenna.

FIG. 16 is a perspective view illustrating the internal antenna and theantenna circuit board.

FIG. 17 is a perspective view illustrating an exploded view of the tophousing cover including a display lens cover.

FIG. 18 is a perspective view illustrating another exploded view of thetop housing cover with the display lens cover removed from the tophousing cover.

FIG. 19 is a perspective view illustrating a bottom side of the patientprogrammer of FIG. 7, including a battery door.

FIG. 20 is a perspective view illustrating a clinician programmer thatmay be used with a medical device as described herein.

FIG. 21 is a perspective view of the clinician programmer of FIG. 19.

FIG. 22 is a perspective view illustrating a medical device systemincluding a clinician programmer, patient programmer and implantablemedical device.

FIG. 23 is a conceptual side view of an antenna circuit board for use ina programmer.

FIG. 24 is a plan view of a ground plane for an antenna circuit board asshown in FIG. 23.

FIG. 25 is a plan view of a first signal plane for an antenna circuitboard as shown in FIG. 23.

FIG. 26 is a plan view of a second signal plane for an antenna circuitboard as shown in FIG. 23.

DETAILED DESCRIPTION

FIG. 1 is a conceptual diagram illustrating a system 10 for programmingand delivering medical therapy to a patient 18. In the example of FIG.1, system 10 includes an implantable medical device 12, in the form ofan implanted neurostimulator, that delivers neurostimulation therapy topatient 18. Hence, IMD 12 may be an implantable pulse generator, and maydeliver neurostimulation therapy to patient 18 in the form of electricalpulses. In some embodiments, IMD 12 may include a rechargeable batterypower supply that can be transcutaneously recharged periodically tomaintain operating power within the IMD. System 10 may incorporate oneor more of a variety of features designed to enhance performance,support mobility and compactness, or promote patient convenience.

IMD 12 delivers neurostimulation therapy to patient 18 via leads 14A and14B (collectively “leads 14”). Leads 14 may, as shown in FIG. 1, beimplanted proximate to the spinal cord 16 of patient 18, and IMD 12 maydeliver spinal cord stimulation (SCS) therapy to patient 18 in order to,for example, reduce pain experienced by patient 18. However, theinvention is not limited to the configuration of leads 14 shown in FIG.1 or the delivery of SCS therapy. For example, one or more leads 14 mayextend from IMD 12 to the brain (not shown) of patient 18, and IMD 12may deliver deep brain stimulation (DBS) therapy to patient 18 to, forexample, treat tremor or epilepsy. As further examples, one or moreleads 14 may be implanted proximate to the pelvic nerves (not shown) orstomach (not shown), and IMD 12 may deliver neurostimulation therapy totreat incontinence or gastroparesis.

IMD 12 delivers neurostimulation therapy to patient 18 according to oneor more neurostimulation therapy programs. A neurostimulation therapyprogram may include values for a number of parameters, and the parametervalues define the neurostimulation therapy delivered according to thatprogram. In embodiments where IMD 12 delivers neurostimulation therapyin the form of electrical pulses, the parameters may include pulsevoltage or current amplitudes, pulse widths, pulse rates, and the like.Further, each of leads 14 includes electrodes (not shown), and theparameters for a program may include information identifying whichelectrodes have been selected for delivery of pulses according to theprogram, and the polarities of the selected electrodes.

System 10 also includes a patient programmer 20. Programmer 20 may be ahandheld computing device. Ideally, the handheld patient programmer 20should be small enough to be concealed discreetly by the patient andstill result in reliable RF communication with IMD 12. Patientprogrammer 20 includes a processor 22 that executes instructions storedin memory 24 to control functions performed by the patient programmer.Processor 22 may include a microprocessor, a controller, a DSP, an ASIC,an FPGA, discrete logic circuitry, or the like.

Patient programmer 20 further includes a display 28, such as a LCD, LEDor plasma display, to display information to a user. Programmer 20 mayalso include a user input device 26, which may be used by a user tointeract with programmer 20. In some embodiments, display 28 may be atouch screen display, and a user may interact with programmer 20 viadisplay 28. A user may also interact with programmer 20 using peripheralpointing devices, such as a stylus or mouse. User input device 26 maytake the form of an alphanumeric keypad or a reduced set of keysassociated with particular functions.

Processor 22 drives display electronics associated with display 28 topresent status information and other data to patient 18. Advantageously,display 28 may provide graphical information, textual information, orboth to indicate the status of operation of programmer 20 and IMD 12.Consequently, when changing programs, device settings (such asneurostimulation parameter settings, or other features, patient 18 mayreceive visual feedback directly from programmer 20 as to the status ofthe changes. Thus, in the context of neurostimulation, for example,patient 18 need not rely merely on changes in sensation (e.g.,paresthesia) or audible beeps indicating the progress of changes toassess whether the changes have been made. Visual presentation ondisplay 28 may be provided in conjunction with audible tones, beeps, oreven audible voice advisories.

Also, programmer 20 may interact with IMD 12 to assess operation andstatus of the IMD 12. For example, programmer 20 may interrogate IMD 12to ascertain the charge status of a rechargeable battery power supplywithin IMD 12. In this manner, programmer 20 may advise patient 18 ofthe current charge status, and indicate when recharge is necessary oradvisable. The charge status may be presented to patient 18 on display28 as a percentage, number, bar representation, or other graphical,textual or iconic representation that conveys to the patient the batterycharge status within IMD 12. Of course, display 28 may also convey thebattery charge status for batteries within programmer 20 itself, in asimilar manner to the presentation of battery charge for IMD 12.

Further, in some embodiments, display 28 may provide the opportunity topresent graphical depictions of the status of IMD 12, including thestatus of leads and electrodes and portions of the body targeted fortherapy by those leads and electrodes. Also, when an external antenna isused for telemetry with IMD 12, display 28 may present an indication ofthe location of the antenna relative to the IMD 12 for a telemetrysession, e.g., based on telemetry signal strength between the antennaand IMD 12.

In addition, processor 22 receives user input entered by a user via userinput 26 to control various operations performed by patient programmer20. Processor 22 also controls a telemetry interface 30 to transmit andreceive information, such as instructions and status information. Inparticular, telemetry interface 30 drives one or both of an internalantenna 32 and an external antenna 34 to transmit instructions to IMD12. In addition, telemetry interface 30 processes signals received byinternal antenna 32 and external antenna 34 from IMD 12. Internalantenna 32 is mounted within a housing associated with patientprogrammer 20, whereas external antenna 34 extends outward from patientprogrammer 20 via an antenna cable. Notably, as shown in FIG. 1,programmer 20 may include both a display 28 and internal antenna 32.

Patient 18 carries programmer 20 and uses the programmer to programneurostimulation therapy for the patient throughout the course of thepatient's day. Again, however, certain aspects of the invention are notlimited to patient programmers, but also may contemplate clinicianprogrammers. For a neurostimulation application, if IMD 12 isappropriately configured, programmer 20 may control IMD 12 to supportdelivery of multiple programs simultaneously, in an interleaved manner.For example, two or more programs may be delivered on an interleavedbasis. This is beneficial because it affords the physician moreflexibility when attempting to cover a patient's pain area withparesthesia. Additional programs give the physician more options tooptimize the pain area with paresthesia, when needed.

In the interest of portability, patient programmer 20 further includes abattery power supply 36, as mentioned above. Patient 18 may useprogrammer 20 to select different programs or modify parameter settings,such as amplitude, rate, electrode configuration, and the like toenhance therapeutic effects. Program or parameter changes may beappropriate for changes in physical activities, postures, time of day,or other events. Different programs or parameters may have differentresults in terms of symptom relief, coverage area relative to symptomarea, and side effects.

A clinician programmer (not shown) may be used by a clinician to createneurostimulation therapy programs and load the programs either intomemory associated with IMD 12 or patient programmer 20. Hence, in someembodiments, patient programmer 20 may be configured to downloadprograms stored in memory associated with the patient programmer to IMD12 to initiate new programs or modify existing programs. In otherembodiments, however, patient programmer 20 merely communicatesinstructions to IMD 12 to select different programs or parameterssettings from memory in the IMD. Memory 24 of patient programmer 20 mayinclude a nonvolatile form of read-only memory (ROM), such as flashmemory, EEPROM, FPGA, CPLD, or the like, and may store applicationsoftware for execution of instructions by processor 22, deviceparameters, use data, diagnostic data, and other software relatedinformation. Read-only memory contents are retained without applicationof power. Alternatively, or in addition, memory 24 may include randomaccess memory (RAM).

In order to modify programs and parameter settings and otherwise controlIMD 12, patient programmer 20 communicates with IMD 12 via wirelesstelemetry techniques. For example, programmer 20 may communicate withIMD 12 via RF telemetry. In this manner, patient programmer 20 is usedby patient 18 to control the delivery of neurostimulation therapy by IMD12. For telemetry with IMD 12, patient programmer 20 may use eitherinternal antenna 32 or external antenna 34 on a selective basis.

External antenna 34 may be attached to the patient programmer 20 via acable, and many include an RF telemetry head for placement on thepatient's body at a position near IMD 12. Internal antenna 32 is mountedwithin or on the housing of patient programmer 20, and may have astructure designed for performance and compactness. In addition,internal antenna 32 may facilitate programming of the IMD 12 by simplyplacing the patient programmer 20 on the patient's body at a positionnear the implanted medical device, thereby promoting patientconvenience.

Display 28 and associated display electronic can produce significantelectrical and electromagnetic interference capable of degrading theperformance of internal antenna 32 during telemetry sessions. Thisinterference may be particularly troublesome due to the relatively closeproximity of internal antenna 32 to display 28 within the housing ofpatient programmer 20. For this reason, processor 22 or other controlcircuitry within patient programmer 20 may be configured to selectivelydisable, i.e., turn off, display 28 and associated display electronicsduring RF telemetry with internal antenna 32 to promote more reliablecommunication. For example, display 28 and display electronics may betemporarily disabled during reception of RF signals, transmission of RFsignals, or both, by internal antenna 32.

In this manner, patient programmer 20 selectively controls the display28 and display electronics to reduce electrical and electromagneticinterference. Processor 22 then enables the display 28 and displayelectronics upon completion of telemetry using internal antenna 32. Insome embodiments, patient programmer 20 may control display 28 todisplay information at a lower intensity, rather than turning off thedisplay. When use of an external antenna 34 is detected, processor 22may enable display 28, as interference may be less of a concern for theexternal antenna, which extends away from patient programmer 20 via acable.

FIG. 2 is a block diagram illustrating patient programmer 20 in greaterdetail. As shown in FIG. 2, display 28 may include an LCD module with anLCD lighting source. In other embodiments display 28 may comprise aplasma display, or the like, that is capable of presenting an icondriven graphical user interface (GUI). However, in this disclosure, theterm display is not meant to include indicator LEDs or othernon-graphical signals. Also, user input device 26 may include a pushbutton matrix. The push button matrix 26 corresponds to a matrix ofinput buttons used by patient 18 to alter stimulation parameters andmaneuver through the GUI presented by display 28.

An infrared (e.g., IRDA) interface 38 may be provided for upgrades,updates, and reprogramming of the embedded operating system of patientprogrammer 20 in the field or clinic. The infrared interface 38 may alsoinclude a controller (not shown) to control IRDA interface 38 toinitiate an infrared communication session for a period of timefollowing power-up of programmer 20. A software loading port 40, such asa Joint Test Action Group (JTAG) interface, conforming to IEEE 1149.1boundary-scan standard, may be provided, in addition to infraredinterface 38, to initially load the embedded operating system intopatient programmer 20 and, in particular, into a system memory 24.

Loading interface 40 may be accessible after substantial manufacture ofprogrammer 20 to allow generic programmers to be assembled and laterprogrammed to fill orders. Loading interface 40 may be generallyinaccessible after substantial manufacture of programmer 20, e.g., afteraccess to loading interface 40 is blocked by completion of the housingof the programmer 20. Infrared interface 38 may be accessible aftercomplete manufacture of programmer 20, and exposed by the housing of theprogrammer.

The infrared interface 38 for updates and upgrades in the field may beprovided in addition to a software loading interface 40 that is used toinitially load the operating system software and application softwareupon manufacture and assembly of the programmer. In some embodiments,infrared interface 38 may be alternatively realized by different typesof communication devices, such as an RF communication device thatcommunicates according to wireless communication technologies such asIEEE 802.11a, 802.11b, 802.11 g, or Bluetooth. In this case, a similarlistening period may be provided upon power-up to permit communicationwith a field programmer.

Telemetry interface 30 includes transmit and receive circuitry, and maybe selectively coupled to internal antenna 32 or external antenna 34 viaa switch 41. Programmer 20 may include further circuitry to detectexternal antenna 34, and drive display 28 and telemetry interface 30based on the detection. Battery power supply 36, in some embodiments,may include one or more alkaline batteries, e.g., AA or AAA batteries,that may be replaced when they are depleted via a door or other accessopening in the housing of patient programmer 20. In some cases, thebatteries may be rechargeable. The batteries may be placed proximateinternal antenna 32 and provide a load to enhance noise immunity toexternal magnetic interference. A power management circuit 43 deliverspower from battery power supply 36 to various components of patientprogrammer 20. An audio transducer 45 may be provided to emit audiblebeeps or tones in response to button or keypad entries by the patient18, or other events.

FIG. 3 is a flow diagram illustrating a technique for selectivelyenabling and disabling display 28 and associated display electronics toreduce electrical and electromagnetic interference during telemetrysessions using internal antenna 32. As shown in FIG. 3, the techniqueinvolves activating telemetry interface 30 (42) within patientprogrammer 20 to initiate a communication session with IMD 12. If theexternal antenna 34 is connected (44) to the patient programmer 20,display 28 is enabled by processor 22 so that patient 18 can view thedisplay during the telemetry session, if desired. Telemetry integrity ofexternal antenna 34 is not compromised by display 28 due to the lengthof the cable used to couple external antenna 34 to programmer 20.

If external antenna 34 is not connected (44), or in some embodiments ifpatient 18 has designated that external antenna will not be used,processor 22 disables display 28 (46) to reduce potential electrical andelectromagnetic interference caused by the display and associateddisplay electronics. Space constraints within programmer 20 causetelemetry via internal antenna 32 to be disrupted by display 28. In someembodiments, processor 22 may disable various electronics on an entirecircuit board on which display 28 is mounted.

In either case, disabling display 28 reduces electrical andelectromagnetic interference, thereby avoiding degradation of telemetryperformance when internal antenna 32 is used. Upon deactivatingtelemetry interface 30 (48), i.e., at the end of or during a pause inthe telemetry session with IMD 12, processor 22 enables display 28 sothat the display can present information to the user (50). In someembodiments, processor 22 also may selectively disable audio transducer45 during telemetry to avoid any electrical and electromagneticinterference that may be caused by operation of the audio transducer.

FIG. 4 is a perspective view of patient programmer 20. As shown in FIG.4, patient programmer 20 includes a housing 47. Housing 47 may have aheight of approximately 8 to 10 cm, a width of approximately 5 to 6 cm,and a thickness of approximately 2 to 3 cm. Housing 47 may be formed ofmolded plastic and may include a front housing cover 96 and a bottomhousing cover 98, as well a lens cover faceplate 68 with a transparentdisplay section 72. Faceplate 68 may be formed of a clear plasticmaterial. Front cover 96 includes a number of input buttons 52, 54, 55,56, 58, 60, 62. More specifically, front cover 96 may include aperturesthat permit buttons 52, 54, 55, 56, 58, 60, 62 to protrude through thefront cover from the interior of housing 47. Front cover 96 alsoincludes an infrared interface window 70 that exposes an infrared (e.g.,IRDA) transmitter and receiver.

Buttons 52, 54 are minus and plus buttons, respectively, that may permitpatient 18 to decrease and increase values of neurostimulation parametersettings. In particular, buttons 52, 54 may permit patient 18 to quicklyincrease and decrease the amplitude of stimulation being delivered byIMD 12. Button 55 is an on/off button that turns power on and off, andturns backlighting on and off. Button 62 is a four-way (up, down, left,right) rocker switch that permits navigation through items presented ondisplay 28.

Buttons 60 may be devoted to a variety of functions such as activationof stimulation, deactivation of stimulation, and interrogation of IMD 12to check device status. The device status may include remaining batterypower and current stimulation parameter settings, and may be displayedon display 28. Buttons 56, 58 correspond to software-defined soft keys64, 66, respectively, which are presented by display 28. The displayedsoft keys 64, 66 may be flexibly reprogrammed to accommodate differentfunctions, features, treatments and contexts. Each button 56, 58, upondepression, specifies user input with respect to the soft keys 64, 66.Any of buttons 52, 54, 55, 56, 58, 60, 62 may have different tactilesurfaces or sensations, e.g., different pressures, when pushed to permitthe patient to more readily differentiate the buttons.

FIG. 5 is a partially exploded view of a patient programmer 20 of FIG.4. As shown in FIG. 4, lens cover faceplate 68 includes apertures toaccommodate buttons 56, 58. Again, faceplate 68 may be formed from aclear plastic material. However, a portion of faceplate 68 may beprinted to frame a transparent area 72 that exposes display 28 forviewing by the user. Faceplate 68 may be printed with personalizationinformation used to identify a patient or a clinic. Further, faceplate68 may be printed with graphics or text to match the type of IMD 12 thatpatient programmer 20 is programmed to control. Faceplate 68 may bedesigned to fit a configuration of patient programmer 20. For example,faceplate 68 may include additional apertures or no apertures toaccommodate the number of buttons included on patient programmer 20.Also, faceplate 68 may be a specific size and/or shape to fit theallotted area within front cover 96.

A software loading interface 74, such as a JTAG interface, is providedwithin patient programmer 20 under faceplate 68. Front housing cover 96defines an aperture for access to software loading interface 74.Software loading interface 74 of FIG. 5 may correspond to softwareloading interface 40 of FIG. 2. Accordingly, patient programmer 20 maybe almost fully assembled, except for insertion of faceplate 68, beforesoftware loading. Prior to insertion of faceplate 68, the embeddedoperating system in patient programmer 20 may be loaded, updated, orupgraded via software loading interface 74. A programming device (notshown) may be applied to loading interface 74 via front cover 96 to loadthe software instructions selected based on the function desired forprogrammer 20.

One advantage of that configuration is the ability to pre-manufacturepatient programmers. A plurality of generic patient programmers may bemanufactured and stored until a specific type of programmer 20 isordered for a particular IMD 12. The generic patient programmers arethen programmed with the software appropriate for a desired type of IMD12 via software loading interface 74. Faceplate 68 conforming to theconfiguration of patient programmer 20 and the type of IMD 12 is thenplaced within front cover 96, such that the transparent area 72 exposesdisplay 28 and software loading interface 74 is covered.

For example, software loading interface 74 may be exposed via a fronthousing cover 96, e.g., prior to place of a lens cover faceplate overthe front housing cover. The front housing cover 96 presents an aperturethat permits access to the software loading interface 74, but is coveredby the lens cover faceplate 68 when it is placed in the front coverhousing. In this manner, patient programmer 20 may be programmed as oneof the final steps in the manufacturing process. A programming head (notshown) may be sized and shaped to engage the software loading interface74 and download software from a host computer such as a handheldcomputing device.

Again, this feature enables a large number of programmers to bepreassembled, placed in storage if desired, and then programmed foroperation with an appropriate type of neurostimulator, e.g., just beforethe lens cover faceplate is placed in the front housing cover. Hence,large numbers of programmers 20 can be stockpiled, and then loaded withappropriate operating system and application software to speciallyconfigure the programmer for use with a specific neurostimulator.

Programmer 20 also includes infrared interface 70 to receive softwarechanges after programmer 20 has been fully assembled. Infrared interface70 may correspond to IRDA interface 38 of FIG. 2. Bottom cover 98 andfront cover 96 form an aperture to allow access to infrared interface70. A controller may control infrared interface 70 to initiate aninfrared communication session for a period of time, such asapproximately 5 to 10 seconds, following power-up of programmer 20. Ifan infrared source is applied to infrared interface 70 during the periodof time immediately following power-up, the controller maintains theinfrared communication session until the software changes are uploaded.Hence, upon power-up of programmer 20, e.g. by replacement of batteriesor activation of an “on” button, infrared interface 70 is powered up andenters a short listening period to establish communication with a fieldprogrammer, if present.

The field programmer may be a PDA with its own infrared port, and may beequipped to download software changes to programmer 20 via infraredinterface 70. If no external infrared interface is detected before theend of the short listening period, infrared interface 70 is deactivated.The software changes may include changes to the operating system of theprogrammer 20, and changes to the neurostimulation programs of IMD 12.In general, the IRDA standard facilitates the point-to-point orpoint-to-multipoint communication between electronic devices such ascomputers, mobile phones, and other devices.

In some embodiments, infrared interface 70 may be generally compliantwith the IrDA Serial Infrared Physical Layer Specification (IrPHY)Version 1.3 (Oct. 15, 1998). Infrared interface 70 may implement theLow-Power Option and be hardware-limited to a maximum baud rate of 38.4kilobits per second. Communication relies on a directed infraredcommunications link over a relatively short distance, on the order ofless than or equal to approximately 1 meter. Infrared interface 70includes an infrared transmitter and receiver for two-way communicationwith another device.

In the event programmer 20 is a patient programmer, the other device maybe a clinician programmer or a dedicated field programmer such as a PDAwith an infrared interface, or programmer 20 may communicate with bothdevices. Upon power-up, infrared interface 70 detects whether aclinician programmer, field programming device, or other device is inthe vicinity of programmer 20. If so, programmer 20 establishescommunication to update software or firmware within the programmer.

FIG. 6A is a perspective view of an external antenna 34 for use with apatient programmer 20. As shown in FIG. 6A, external antenna 34 includesa cable 86 and a loop-like telemetry head 74 at one end of the cable.The loop-like telemetry head 74 is placed on the patient's body at aposition near IMD 12. The loop-like telemetry-head may define a uniqueaperture 78 with a wide end 80 and a narrow, tapered end 82, e.g.,somewhat similar to the shape of a tear drop.

The narrow, tapered end 82 of the aperture defines a channel or “notch”designed to capture clothing worn by the patient to thereby hold thetelemetry head 74 in place near IMD 12 during programming. When theclothing, such as a shirt, is forced into the channel, friction tends tohold the clothing and the telemetry head 74 in place relative to oneanother. FIG. 6B is a perspective view of telemetry head 74 and cable86. In FIG. 6B, telemetry head 74 is attached to a patient's shirt. Inparticular, part of the patient's shirt is held in place within thechannel defined by narrow, tapered end 82 to thereby hold telemetry head74 in place relative to an IMD 12.

The configuration shown in FIGS. 6A and 6B allows relatively stablepositioning of external antenna 34 relative to IMD 12. Patient 18 doesnot need to physically hold external antenna 34 in position relative toIMD 12. Therefore, patient 18 may have both hands free to manipulateprogrammer 20, update neurostimulation programs, change neurostimulationparameters in IMD 12, or handle other tasks.

As further shown in FIGS. 6A and 6B, telemetry head 74 may be formedfrom molded plastic 76 and include rubberized grip surfaces 84A, 84B.Cable 86 may include strain relief sections 88, 94, a filter 90, and aplug 92 for plugging the cable into a jack provided in patientprogrammer 20. The jack provided by programmer 20 also couples externalantenna 34 to telemetry interface 30, from FIG. 2. Cable 86 carries aconductor that couples to a conductive antenna loop within telemetryhead 74. In FIG. 6A, cable 86 appears to be relatively short but can beapproximately two to three feet long if desired. The length of cable 86allows programmer 20 to perform telemetry via external antenna 34 withdisplay 28 enabled. The distance between external antenna 34 and display28 reduces interference to telemetry generated by display 28.

FIG. 7 is a perspective view of patient programmer 20. Patientprogrammer 20 is designed to appear similar to a pager or other common,small electronic device, and not necessarily like a medical device.Patient 18 may discreetly carry and use programmer 20. An internalantenna 32 (not shown in FIG. 7) further allows patient 18 to modify theperformance of IMD 12 by simply holding programmer 20 in a positionrelative to IMD 12. In that way, patient 18 is not required to carry anexternal antenna 34 at all times.

FIG. 8 is a perspective view illustrating the patient programmer 20 ofFIG. 7 with the front cover 96 removed and an interior view of the tophousing cover. As shown in FIG. 8, bottom cover 98 contains a displaycircuit board 104 and an antenna circuit board 106 stacked on top of oneanother. Display circuit board 104 carries display 28 and associateddisplay electronics. In addition, display circuit board 104 carries anumber of user input switches 103 that correspond to a push buttonmatrix 26, from FIG. 2.

The input switches 103 receive input from various buttons 55, 56, 58,60, 62. The buttons may be formed in part by rubber button molding 100,placed between display circuit board 104 and front cover 96, thatinterfaces with the switches. Input switches 105 are carried by antennacircuit board 106, and interface with button molding 102. Button molding102 forms buttons 52 and 54 which allow control of the stimulationamplitude. Switches 103 may be formed as conventional snap domeswitches.

Front cover 96 includes an aperture 72 to allow a user to view display28 mounted on display circuit board 104. Front cover 96 also includes anaperture to allow access to software loading interface 74. In theembodiment shown in FIG. 9, button molding 100 also includes an aperturefor software loading interface 74. In other embodiments, button molding100 may comprise a different configuration and number of buttons thanthat shown in FIG. 9.

FIG. 9 is a perspective view illustrating the patient programmer of FIG.7 with the top housing cover 96 and display circuit board 104 removed.FIG. 9 reveals an antenna circuit board 106 that lies beneath displaycircuit board 104. A connector 107 included on a top side of antennacircuit board 106 serves to connect antenna circuit board 106 to displaycircuit board 104 via another connector (not shown) included on a bottomside of display circuit board 104.

Antenna circuit board 106 may carry telemetry circuit electronics, powermanagement electronics and, on a bottom side, internal antenna 32.Display circuit board 104 may carry control circuitry, display circuitryelectronics, and on a top side, display 28. Antenna circuit board 106provides power to display circuit board 104 via electrical connector107.

In some embodiments, the control circuitry on display circuit board 104controls display 28 and the telemetry circuit electronics on antennacircuit board 106 via connector 107. Hence, the intelligence to controloperations of both display circuit board 104 and antenna circuit board106 may be mounted on a single one of the boards, such as displaycircuit board 104. The intelligence, in the form of a processor, logiccircuitry of other equivalent structure, may interact with components onboth boards 104, 106 via electrical connector 107.

Consequently, software may be initially loaded via software loadinginterface 74, as described herein, to program a processor on only one ofthe boards 104, 106, such as display circuit board 104. In someembodiments, a processor on display circuit board 104 may be programmedfor use with particular types of IMDs, or for use with different antennacircuit boards 106 have different features. In this manner, displaycircuit board 104 may be generically constructed for modular use in avariety of programmers, but then specifically programmed for a givenapplication.

Internal antenna 32 is placed as far away from display 28 as possiblewithin the reasonable size limits of handheld programmer 20. However,telemetry via internal antenna 32 can still be adversely impacted byelectrical and electromagnetic noise generated by display 28 when it isenabled. Therefore, control circuitry, such as processor 22, may beconfigured to selectively disable display 28 during telemetry viainternal antenna 32, in accordance with the invention.

To further reduce electrical and electromagnetic interference, in someembodiments, display circuit board 104 may be designed to include amajority of digital components, such as display, processor and memorycircuitry, and antenna circuit board 106 may be designed to include amajority of analog components, such as telemetry and power supplycircuitry. In either case, the control circuitry may selectively disabledisplay circuit board 104 during telemetry via internal antenna 32 tosubstantially eliminate digital noise associated with display 28.

FIG. 10 is a perspective view illustrating the patient programmer ofFIG. 7 with the top housing cover 96, display circuit board 104 andantenna circuit board 106 removed. As shown in FIG. 10, bottom cover 98defines a battery bay 108. Battery bay 108 may be formed by arectangular raised wall that is molded into bottom cover 98. Battery bay108 may be shaped and sized to accommodate one or more batteries topower the components in patient programmer 20. In the embodiment shownin FIG. 10, battery bay 108 is sized to accommodate two AAA alkalinebatteries for purposes of illustration. The rectangular raised wallprotrudes into patient programmer 20 such that the wall and thebatteries in battery bay 108 are substantially adjacent to a bottom sideof antenna circuit board 106. Battery bay 108 is entirely containedwithin patient programmer 20, and consumes some of the depth of thepatient programmer housing.

As shown in FIG. 10, in accordance with the invention, patientprogrammer 20 may be assembled by stacking components 98, 106, 104, 96on top of one another in a z-axis technique. The z-axis technique allowsthe assembly process to be at least partially automated, and generallyrefers to the stacking of components, one on top of the other, frombottom to top. For example, antenna circuit board 106 is placed intobottom housing cover 98.

Display circuit board 104 is then placed over antenna circuit board 106and coupled to antenna circuit board 106 via electrical connector 107.Front cover 96 is placed over display circuit board 104 to substantiallyenclose the display and antenna circuit boards 104, 106 within frontcover 96 and bottom housing cover 98. In some embodiments, the placementof button moldings 100, 102 over display circuit board 104 prior to theplacement of front cover 96 is also automated. After programmer 20 issubstantially assembled, as described above, software is loaded into amemory 24 via software loading interface 40 through an aperture in frontcover 96. A faceplate 68 is then placed over front cover 96 to coverloading interface 40 and expose display 28 for viewing, providing acomplete assembly.

FIG. 11 is a perspective view illustrating the patient programmer ofFIG. 7 with the top housing cover 96, display circuit board 104 andantenna circuit board 106 removed, and an antenna-side view of theantenna circuit board, i.e., a view of the antenna circuit board from aside on which the antenna is mounted. As shown in FIG. 11, antennacircuit board 106 carries internal antenna 32. Internal antenna 32 mayhave a loop-like structure 110 that defines a central aperture 112. Insome embodiments, the loop-like structure 110 may be substantiallyrectangular. The central aperture 112 may be shaped and sized to permitinsertion of one or more batteries placed in battery bay 108 of bottomhousing cover 98. Battery bay 108 may protrude into the antenna aperture112 when programmer 20 is fully assembled. The batteries may rest on thesurface of antenna circuit board 106.

The batteries may be placed in the battery bay via an access door on theoutside of the patient programmer housing. The access door may be ahinged door or a removable, sliding door. In some cases, the batteriesin battery bay 108 may contribute favorably to the RF load presented tothe internal antenna 32. In particular, the batteries contained withinloop-like structure 110 may present an additional load to the internalantenna 32 that enhances immunity to electrical and electromagneticinterference from external magnetic fields during telemetry sessionswith the IMD 12. To further reduce electrical and electromagneticinterference, the internal antenna 32 may be constructed with a wovencopper braid that enhances shielding and reduces antenna loading duringtransmission and reception.

FIG. 12 is a perspective view illustrating the antenna circuit board 106and bottom housing cover 98 of the patient programmer 20 of FIG. 7.Internal antenna 32 is mounted away from antenna circuit board 106 tomaximize the distance between internal antenna 32 and display 28 mountedon display circuit board 104. In some embodiments, antenna 32 may besecurely mounted within an annular, recessed area in bottom housingcover 98 that surrounds battery bay 108.

For example, antenna 32 may be mounted on a carrier that is welded tobottom housing cover 98. The space between antenna circuit board 106 andloop-like structure 110 is substantially filled by battery bay 108extending into antenna aperture 112. The placement of battery bay 108within aperture 112 enables programmer 20 to maintain a smaller size.Also, the batteries placed in battery bay 108 within aperture 112 reduceexternal magnetic interference to internal antenna 32 by providing an RFload to the internal antenna, enhancing noise immunity.

FIG. 13 is a perspective view illustrating a side view of the displaycircuit board 104 and the antenna circuit board 106. FIG. 14 is aperspective view illustrating a second side view of the display circuitboard 104 and the antenna circuit board 106. As shown in FIGS. 13 and14, the loop-like structure 110 of internal antenna 32 is displaced fromthe surface of antenna circuit board 106. Loop-like structure 110 ismounted to a connector 113 on the surface of antenna circuit board 106.The connector couples internal antenna 32 to telemetry circuitry 30. Ajack 114 is provided on antenna circuit board 106 to receive plug 92from external antenna 34. Jack 114 couples external antenna 34 totelemetry interface 30. Display 28 is mounted to the surface of displaycircuit board 104 and is coupled to display circuitry.

Display circuit board 104 and antenna circuit board 106 are coupled toeach other by an electrical connector interface. The electricalconnector interface (not shown) allows the circuitry on the two circuitboards to interact. For example, antenna circuit board 106 includespower control circuitry that powers both circuit boards 104 and 106, aswell as telemetry circuitry. The power control circuitry may include adc-dc converter to convert power from batteries to operating power forthe various components within programmer 20.

Additionally, display circuit board 104 includes control circuitry, suchas processor 22, to control both display 28 and telemetry interface 30.The control circuitry may selectively disable or enable display 28 andrelated display circuitry based on whether external antenna 34 isconnected to programmer 20 via jack 114. If so, display 28 can beenabled because the electrical and electromagnetic noise generated bythe display is less likely to have an adverse effect on telemetry viaexternal antenna 34.

To reduce the effects of electrical and electromagnetic interferenceproduced by display 28, and associated display electronics, on telemetryperformance, the display and internal antenna 32 may be displaced fromone another within the patient programmer housing, as shown in FIGS. 13and 14. For example, the display 28 and associated display electronicsare mounted on a display circuit board 104, and internal antenna 32 andassociated transmit and receive electronics may be mounted on antennacircuit board 106.

The display and antenna circuit boards 104, 106 occupy different planes,displaced from one another, within the housing of patient programmer 20.Hence, processor 22 may be configured to drive telemetry electronics onantenna circuit board 106, yet reside on a different board, e.g.,display circuit board 104. However, display 28 and internal antenna 32may overlap one another, providing a compact, stack-like configuration.Internal antenna 32 may be mounted on an outward-facing side of theantenna circuit board 106, and the display 28 may be mounted on anoutward-facing side of the display circuit board 104. The internalantenna may be mounted in bottom housing cover 98 above the surface ofthe circuit board via a connector. In this manner, the internal antennaalso may be displaced from the second circuit board.

The separation distance between the circuit boards 104, 106 may serve toreduce the effects of electrical and electromagnetic interference causedby the display 28 on signals transmitted and received by the internalantenna 32. In addition, the placement of the telemetry electronics anddisplay electronics on different circuit boards may reduce interference.In summary, the internal antenna arrangement provides a compact design,but reduces the effects of circuit board noise on telemetry performancedue to operation of display 28.

A majority of digital electronics may be placed on the display circuitboard 104 with the display 28, and a majority of analog and RFelectronics may be placed on the antenna circuit board 106.Consequently, much of the digital electronics on the display circuitboard 104 may be selectively turned off during telemetry sessionsadministered by analog components on the other circuit board 106.

In some embodiments, for purposes of illustration, the center planes ofthe display circuit board 104 and the antenna circuit board 106 may beapproximately 0.3 to 1.0 cm apart. The internal antenna 32, mountedabove antenna circuit board 106, may be approximately 1.0 to 1.5 cm awayfrom the center plane of the display circuit board, and approximately1.2 to 2.0 cm away from the backplane of display 28. Loop-like structure110 of internal antenna 32 may have an inner dimension (i.e., ofaperture 112) of approximately 5.5 to 6.5 cm in length by approximately2.8 to 3.2 cm in width, and an outer dimension of approximately 6.5 to7.5 cm in length by approximately 4.2 to 4.6 cm in width. Display 28 mayhave a dimension of approximately 3.0 cm by approximately 4.3 cm.

FIG. 15 is a perspective view illustrating the bottom housing cover 98with a battery bay 108 and loop-like structure 110 of internal antenna32. As shown in FIG. 15, loop-like structure 110 extends about therectangular wall of battery bay 108, and resides in a recess between theouter walls of bottom cover 98 and the battery bay. Thus, battery bay108, and batteries placed in the battery bay, protrude upward throughthe aperture defined by loop-like structure 110. Accordingly, thebatteries fill a portion of the aperture, and provide an additional loadthat enhances noise immunity for internal antenna 32.

FIG. 16 is a perspective view illustrating the internal antenna 32 andthe antenna circuit board 106. As shown in FIG. 16, antenna 32 may beadhesively bonded to an insulative spacer 116. Internal antenna 32comprises a plastic frame shaped to fit within bottom cover 98 andaround battery bay 108. The plastic frame comprises connector pins tocouple to antenna circuit board 106. Conductive windings wrap around theplastic frame to create internal antenna 32. The conductive windings maybe wrapped about a perimeter of the plastic frame. The plastic frame andconductive windings are then substantially surrounded by a copper braidshielding that is wrapped in successive turns around the plastic frameand windings to block external magnetic interference.

FIG. 17 is a perspective view illustrating an exploded view of the tophousing cover 96 including a display lens cover faceplate 68. Faceplate68 is formed of transparent plastic material, and is printed to form anon-transparent border around a display screen window 72 that exposesdisplay 28 for viewing by patient 18. Also illustrated are buttonmoldings 100, 102, which carry formed buttons 52, 54, 55, 56, 58, 62.

FIG. 18 is a perspective view illustrating another exploded view of thetop housing cover 96 with the display lens cover faceplate removed fromthe top housing cover. Faceplate 68 may be mounted within a recessedarea 115 formed in top cover 96 as the final step in assembly of patientprogrammer 20. Faceplate 68 may be an in-mold decorated lens faceplatethat can be printed with distinctive indicia just prior to assembly tocustomize the appearance of patient programmer 20, and then insertedinto recessed area 115 in the front housing cover 96. Faceplate 68 mayalso be customized for a number of apertures required for buttons on aparticular type of programmer 20. In some cases, the display lens coverfaceplate 68 may be printed with personalization information, such aspatient name, address and phone number.

Also, the display lens cover faceplate 68 may carry different graphicsto distinguish different types of therapy delivered by the IMD 12 withwhich patient programmer 20 is used, or distinguish different modeltypes. The faceplate also may be made with different configurations thatexpose different sets of buttons, and may have different appearances,including different colors, illustrations, and designs, while fitting ina common mounting area defined by recessed area 115. Hence, thefaceplate 68 may be selected from one of a plurality of faceplateshaving different configurations based on a match between theconfiguration of the plate member and a type of neurostimulatorprogrammer being assembled.

For example, various color schemes, graphical motifs, and the like maybe patient-selectable by selecting a particular faceplate 68. Thepatient may enjoy the ability to choose the appearance of programmer 20by choosing a faceplate 68. Although a particular faceplateconfiguration is described and illustrated herein for purposes ofillustration, the size, shape and structure of faceplate 68 should notbe considered limiting. Rather, faceplate 68 may have any of a varietyof different characteristics. Once selected, a particular faceplate 68may be fixed to the housing of programmer 20, e.g., during manufacturingfollowing a pre-order specification of the faceplate. Alternatively, thefaceplate 68 may be readily applied to the housing of programmer 20 and,in some instances, made detachable so that the faceplate may be detachedand replaced with a different faceplate, if desired.

The patient programmer 20 may feature a stacked configuration thatpermits Z-axis assembly of the components of the programmer, includingbottom housing cover 98, internal antenna 32, antenna circuit board 106,display circuit board 104, button moldings 100, 102, top housing cover96, and display lens cover faceplate 68, which protects display 28. Inthis manner, the various components may be stacked on top of one anotherto build the patient programmer 20 from back to front, i.e., in a z-axisorientation. The z-axis assembly can simplify assembly, and permitautomated assembly techniques in some instances.

FIG. 19 is a perspective view illustrating a bottom side of the patientprogrammer 20 of FIG. 7, including a battery door. As shown in FIG. 19,bottom cover 98 of patient programmer 20 may include a hinged batterydoor 116 that provides access to battery bay 108. Accordingly, a patientmay replace batteries within battery bay 108 when the batteries are neardepletion. A low battery indication may be presented by display 28 inresponse to detection of a low battery state by power management module43 (FIG. 2).

FIG. 20 is a perspective view illustrating a clinician programmer 117,with a touchscreen 119, that may be used with a neurostimulation system10 as described herein. FIG. 21 is a perspective view of the clinicianprogrammer 117 of FIG. 20, and further illustrates a stylus 121 for usewith touchscreen 119, and an RF telemetry head 123 attached to theclinician programmer 117 via a cable 125. In operation, a clinician usesclinician programmer 117 to program neurostimulation therapies into IMD12 via RF telemetry using RF telemetry head 123.

FIG. 22 is a perspective view illustrating a neurostimulation systemincluding a clinician programmer 117, patient programmer 20 and IMD 12.The system includes IMD 12, which delivers neurostimulation therapy topatient 18 via one or more implanted leads. Clinician programmer 117 isused by a clinician to program neurostimulation therapy for patient 18.In particular, the clinician may use programmer 117 to createneurostimulation therapy programs. As part of the program creationprocess, programmer 117 allows the clinician to identify parametersettings and electrode configurations that enable IMD 12 to deliverneurostimulation therapy that is desirable in terms of, for example,symptom relief, coverage area relative to symptom area, and sideeffects.

Programmer 117 may also allow the clinician to identify parametersettings that enable IMD 12 to deliver effective neurostimulationtherapy with desirable device performance characteristics, e.g., lowbattery consumption. Programmer 117 controls IMD 12 to test parametersettings in order to allow a clinician to identify desirableconfigurations in an efficient manner. Once clinician programmer 117 hasloaded IMD 12 with neurostimulation therapy programs, the patient thenuses patient programmer 20 to modify and select programs and parametersettings. Clinician programmer 117 may be configured to incorporatefeatures described herein with respect to patient programmer 20.Accordingly, features attributed to patient programmer 20 may beapplicable to the design of other programmers such as a clinicianprogrammer, in accordance with the invention.

FIG. 23 is a conceptual side view of an antenna circuit board 106 foruse in a programmer 20. Antenna circuit board 106 is not necessarily inproportion, but provides an illustration of various layers of thecircuit board, which is coupled to antenna 110 via a connector 137.Connector 137 couples antenna 110 to circuit board 106. As describedherein, antenna 110 may have a loop-like configuration that defines anaperture that may accommodate a battery bay. Antenna circuit board 106may include a ground plane 130, a signal plane 132, and a signal plane134. Optionally, a power plane carrying operating power may be providedwithin circuit board 106, or distributed across signal planes 132, 134.

Dielectric layer 136 separates ground plane 130 and signal plane 132.Similarly, dielectric layer 138 separates ground plane 130 and signalplane 134. Antenna circuit board 106, like display circuit board 104,may be constructed from conventional laminated circuit board materials.Ground plane 130 and signal planes 132, 134 may be formed fromconductive coatings or layers, and etched or printed to define desiredcircuit traces. Signal planes 132, 134 may support a variety of surfacemount components.

In accordance with another embodiment of the invention, ground plane 130and signal planes 132, 134 may be configured to further promotetelemetry performance. For example, ground plane 130 and signal planes132, 134 may be configured to balance two competing objectives. First, asingle, contiguous ground plane area is desirable to provide a lowimpedance return path for electrical signals transmitted via traces onsignal planes 132, 134. A single, substantially contiguous ground plane130 serves to maximize RF signal integrity.

Second, it is desirable to present a minimal magnetic load to themagnetic circuit operating on antenna 110. Reduction or elimination ofsurface area of conductive signal planes 132, 134 within the antennaaperture serves to reduce the magnetic load to the magnetic circuit ofantenna 110. In other words, forming signal planes 132, 134 that defineapertures in alignment with the aperture of antenna 110 cansubstantially reduce the magnetic load. The ground plane and signalplane features described herein may be especially suitable for antennacircuit board 106, but may also be useful with display circuit board104.

Providing a single, contiguous ground plane 130 with signal planes 132,134 defining apertures that correspond to the antenna aperture resultsin losses in the magnetic field strength generated by the antenna 110,and magnetic signal integrity is maximized. The apertures defined bysignal planes 130, 132 may be substantially continuous. Alternatively, a“cross-hatched” conductive pattern within the signal plane areascorresponding to the antenna aperture can present a controlled, reducemagnetic load to the antenna.

FIG. 24 is a plan view of a ground plane 130 for an antenna circuitboard 106 as shown in FIG. 23. As shown in FIG. 24, ground plane 130extends over dielectric layer 138. In particular, ground plane 130 isformed by a conductive layer 139 that extends over a substantial area ofdielectric layer 138 in a substantially contiguous manner. To achieve aworking compromise between RF and magnetic requirements, the single,contiguous ground plane 130 is, in effect, divided into smaller planeareas primarily to minimize magnetic loading of the antenna.

The exact dimensions of each smaller plane area may not be critical tominimizing the loading. However, the desired effect of good RF andmagnetic performance can be realized by incorporating a series ofchannel-like gaps 140A-140D (the various white lines in FIG. 24) thatextend outward from an inner area of ground plane 130 toward outer edgesof antenna circuit board 106. Not all of the gaps are associated withreference numerals due to limitation in the black-on-white presentationof FIG. 24. The width of each gap 140 may vary, but can be on the orderof approximately 0.2 to 3.0 mm.

The spoke-like pattern of gaps may emanate from the center of antennacircuit board and extend outward toward the edges, interrupting thecontinuous ground plane and defining sub-areas. There is no conductivematerial in the gaps 140A-140D. These gaps 140A-140D divide adjacentconductive plane areas of ground plane 130 to prevent large eddycurrents from forming around the perimeter of antenna circuit board 106in the conductive plane because there are no conductive loops around theperimeter of the board.

The island-like plane areas defined by gaps 140A-140D may vary in sizeand shape, and need not be entirely decoupled from one another. Rather,the plane areas may be electrically coupled to another but separated tosome extent by respective gaps 140A-140D. In some embodiments, thenumber of small plane areas defined by gaps 140A-140D may be determinedaccording to the functional grouping of electrical signals carried incorresponding regions of signal planes 130, 132. In order to maintainsignal integrity, for example, all digital signals may be grouped intoone area; all analog signals may be grouped into a second area; and soforth. Each small area of ground plane 130 can provide sufficiently lowimpedance return paths to maintain signal integrity for the respectivesignal groups.

FIG. 25 is a plan view of a first signal plane 132 for an antennacircuit board 106 as shown in FIG. 23. FIG. 26 is a plan view of asecond signal plane 134 for an antenna circuit board 106 as shown inFIG. 23. First signal plane 132 is shown in conjunction with dielectriclayer 136, while second signal plane 134 is shown in conjunction withdielectric layer 138. In the example of FIGS. 25 and 26, the respectivesignal planes 132, 134 may include conductive, electrostatic discharge(ESD) layers 142, 148, respectively.

The respective layers 142, 148 define central apertures 143, 150 thatsubstantially correspond in size and shape to the aperture of antenna110, which is mounted over the signal planes. For example, the apertures143, 150 may approximate the size and shape of the aperture of antenna110, although not necessarily exactly, and are positioned in alignmentwith the antenna aperture. The shapes of ESD layers 142, 148 may beaccomplished by deposition, printing, etching or other fabricationtechniques.

Both layers 142, 148 are dedicated to ESD protection of the antennacircuit board 106 by deliberately bringing the copper out to the leftand right edges 144, 146 of the board 106 and connecting them to themain ground of the board only at the top and middle sections of copper.With this configuration, any ESD events have a known and controlledconductive path to main ground, and the disruptive effects of ESD areminimized. In the example of FIG. 25, the top and bottom edges of thePCB are not as well protected from ESD as the left and right edges, butthese areas are not flooded with copper to prevent magnetic loadingeffects, as described above.

Various embodiments of the invention have been described. However, oneskilled in the art will appreciate that various additions andmodifications can be made to these embodiments without departing fromthe scope of the invention. The invention may be generally applicable toany programmer useful with an implanted medical device, includingpatient programmers or physician programmers within the context of theclinical programming environment. The implantable medical device mayprovide stimulation therapies for pain and movement disorders and mayinclude other stimulation-based therapies as well. Also, programmer inaccordance with the invention may be applicable to other implantablemedical devices such as implantable drug delivery devices, andimplantable cardiac pacemakers, cardioverters, or defibrillators, aswell as non-implanted, external medical devices such as stimulators,drug pumps, or the like, and medical devices including both implantedand external components. These and other embodiments are within thescope of the following claims.

1. A method comprising: activating telemetry circuitry in a programmerfor a medical device, wherein the programmer includes an internalantenna and an external antenna, wherein the telemetry circuitryperforms telemetry via one of the internal antenna and the externalantenna, and wherein the programmer comprises a display and a displaylighting source; disabling the display in the programmer duringactivation of the telemetry circuitry to reduce electrical interferencewhen the telemetry circuitry performs telemetry via the internalantenna; and enabling the display when the telemetry circuitry performstelemetry via the external antenna.
 2. The method of claim 1, whereindisabling the display includes disabling circuitry associated with thedisplay when the telemetry circuitry performs the telemetry via theinternal antenna.
 3. The method of claim 1, wherein the display resideson a circuit board with display circuitry to drive the display, anddisabling the display includes disabling the display and the displaycircuitry.
 4. The method of claim 1, further comprising enabling thedisplay when the telemetry is not activated.
 5. The method of claim 1,wherein the medical device is an implantable neurostimulator, andwherein the telemetry circuitry transmits signals to the implantableneurostimulator via the internal antenna and processes signals receivedfrom the implantable neurostimulator via the internal antenna, themethod further comprising enabling the display when the telemetrycircuitry is not activated.
 6. The method of claim 1, wherein thedisplay is a liquid crystal display.
 7. The method of claim 1, whereinthe telemetry circuitry is on a first circuit board and the display ison a second circuit board.
 8. The method of claim 1, wherein theinternal antenna defines an aperture, and the programmer includes abattery bay extending at least partially into the aperture.
 9. Themethod of claim 1, wherein the telemetry circuitry is coupled to theexternal antenna via a cable, the method including selectivelycommunicating with the medical device via one of the internal antennaand the external antenna.
 10. The method of claim 1, wherein the medicaldevice is an implanted neurostimulator.
 11. The method of claim 1,wherein disabling the display includes disabling electronics onsubstantially an entire circuit board on which the display is mounted.12. A programmer comprising: an internal antenna coupled to a programmerhousing; an external antenna coupled to the programmer housing;telemetry circuitry within the housing to perform telemetry with amedical device via one of the internal antenna and the external antenna;a display within the housing to present information; a display lightingsource; and control circuitry to disable the display in the programmerduring the telemetry to reduce electrical interference when thetelemetry circuitry performs telemetry via the internal antenna, whereinthe control circuitry enables the display when the telemetry circuitryperforms telemetry via the external antenna.
 13. The programmer of claim12, wherein the control circuitry disables circuitry associated with thedisplay when the telemetry circuit performs the telemetry via theinternal antenna.
 14. The programmer of claim 12, wherein the displayresides on a circuit board with display circuitry to drive the display,and the control circuitry disables the display and the displaycircuitry.
 15. The programmer of claim 12, wherein the control circuitryenables the display when the telemetry is not activated.
 16. Theprogrammer of claim 12, wherein the telemetry circuitry transmitssignals to the medical device via the internal antenna and processessignals received from the medical device via the internal antenna, andwherein the control circuitry enables the display when the telemetry isnot activated.
 17. The programmer of claim 12, wherein the display is aliquid crystal display.
 18. The programmer of claim 12, furthercomprising: a first circuit board; and a second circuit board, whereinthe internal antenna and the telemetry circuitry reside on the firstcircuit board and the display resides on the second circuit board. 19.The programmer of claim 12, wherein the telemetry circuitry is coupledto the external antenna via a cable, and the control circuitry selectsone of the internal antenna and the external antenna for telemetry withthe medical device.
 20. The programmer of claim 12, wherein the medicaldevice is an implanted neurostimulator.
 21. The programmer of claim 12,wherein the control circuitry disables electronics on substantially anentire circuit board on which the display is mounted.
 22. A methodcomprising: activating telemetry circuitry in a programmer for animplantable neurostimulator, wherein the programmer includes an internalantenna, an external antenna, and the telemetry circuitry performstelemetry via one of the internal antenna and the external antenna, andwherein the programmer comprises a display and a display lightingsource; communicating with the neurostimulator via the telemetrycircuitry; disabling the display in the programmer during communicationvia the telemetry circuitry to reduce electrical interference when thetelemetry circuitry performs telemetry via the internal antenna; andenabling the display when the telemetry circuitry performs telemetry viathe external antenna.
 23. The method of claim 22, wherein the programmeris a handheld, portable device.
 24. The method of claim 22, wherein thetelemetry circuitry transmits signals to the implantable neurostimulatorvia the internal antenna and processes signals received from theimplantable neurostimulator via the internal antenna, the method furthercomprising enabling the display when the telemetry circuitry is notactivated.
 25. The method of claim 22, wherein disabling the displayincludes disabling electronics on substantially an entire circuit boardon which the display is mounted.
 26. A programmer for an implantableneurostimulator, the programmer comprising: an antenna coupled to aprogrammer housing, wherein the antenna includes an internal antenna,the programmer further comprising an external antenna; telemetrycircuitry within the housing to perform telemetry with theneurostimulator via one of the internal antenna and the externalantenna; a display within the housing to present information; a displaylighting source; and control circuitry to disable the display in theprogrammer during the telemetry to reduce electrical interference whenthe telemetry circuit performs telemetry via the internal antenna,wherein the control circuitry enables the display when the telemetrycircuit performs telemetry via the external antenna.
 27. The programmerof claim 26, wherein the programmer is a handheld, portable device. 28.The programmer of claim 26, wherein the control circuitry disableselectronics on substantially an entire circuit board on which thedisplay is mounted.
 29. A method comprising: activating telemetrycircuitry in a programmer for an implantable medical device, wherein theprogrammer includes a display, an internal antenna and an externalantenna, wherein the telemetry circuitry performs telemetry via one ofthe internal antenna and the external antenna; disabling the displaywhen the telemetry circuitry performs telemetry via the internalantenna; and enabling the display when the telemetry circuitry performstelemetry via the external antenna.
 30. The method of claim 29, whereinthe implantable medical device includes an implantable electricalstimulator.
 31. The method of claim 29, wherein disabling the displayincludes disabling electronics on substantially an entire circuit boardon which the display is mounted.
 32. A programmer for an implantablemedical device, the programmer comprising: an internal antenna mountedwithin the programmer housing; an external antenna coupled to aprogrammer housing; telemetry circuitry within the housing to performtelemetry with an implantable medical device via the internal antenna orthe external antenna; a display within the housing to presentinformation; and control circuitry that disables the display when thetelemetry circuitry performs telemetry via the internal antenna, andenables the display when the telemetry circuitry performs telemetry viathe external antenna.
 33. The programmer of claim 32, wherein thetelemetry circuitry is configured to perform telemetry with animplantable electrical stimulator.
 34. The programmer of claim 32,wherein the control circuitry disables electronics on substantially anentire circuit board on which the display is mounted.